![]() An implication of this concept is that a more severe version of MDD may simply require more of the same treatment as other presentations, rather than a different therapeutic approach required by a distinct illness. ![]() All of these classifications considered psychotic depression to be a severe subtype of major depressive disorder (MDD). In other diagnostic systems, the concept of psychotic depression has variously included a level of severity that leads to distortion of reality, melancholic depression, endogenous depression, or the opposite of neurotic depression (defined in this context as depression with a psychosocial etiology). However, the subsequent version (ICD-11) includes hallucinations and delusions along with severity as diagnostic criteria. In ICD-10, the version that will continue until 2022, psychotic depression is still classified as a type of severe major depression. Although DSM-III eliminated severe impairment as the primary criterion for psychosis, this criterion remained in the International Classification of Diseases (ICD), especially if endogenous features were present. After reports that major depression with delusions had a different treatment response than major depression without delusions, the definition of psychotic depression was modified in DSM-III to require delusions, hallucinations, or depressive stupor.
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